Surgical Instrument

ABSTRACT

A surgical instrument for applying a fastener to tissue. The fastener includes a male component including a base having a hole, a needle receivable in the hole, and a female component including a base and a recess for receiving the needle. The instrument includes a shaft, a first jaw pivotally mounted on the shaft including a receiver for holding the base one component, and a second jaw statically mounted on the shaft including a receiver for releasably holding the base the other component. The first jaw is moveable between an open position and a closed position. The first and/or second jaw includes a channel for slideably receiving a needle. The instrument includes a mechanism for moving the first jaw between the open and closed positions and an ejector for driving the needle through the hole in the male component, through tissue and into the recess of the female component.

BACKGROUND

This invention generally relates to a surgical instrument, and moreparticularly to an instrument for applying a fastener to tissue of apatient.

Gastroesophageal reflux disease or persistent heartburn is caused by animproper relaxation of the lower esophageal sphincter, allowing acidicstomach contents to travel into the esophagus. If left untreated,chronic reflux may cause esophageal stricture, bleeding ulcers,perforation, and scarring. Continued reflux may lead to Barrett'sesophagus, involving changes in the esophageal cells and possiblyleading to cancer. Antacids and proton pump inhibitors are initiallyused to treat this condition. If these treatments are unsuccessful,surgical intervention is often recommended.

One interventional surgical method is known as Nissen fundoplication.This procedure involves wrapping a fundus of the stomach around thelower end of the esophagus and fastening it in place to make the loweresophageal sphincter less compliant. Traditionally, this procedure wasaccomplished by open surgery using sutures to secure the plicated fundusof the stomach around the esophagus without penetrating the stomach.More recently, laparoscopic Nissen procedures have been used. In somelaparoscopic procedures, surgical fasteners are used with an endoscopicapplicator. Several different fastener designs have been developed. Someof these designs include a two piece fastener. A first of these pieces,a male component, includes a base having two straight elongate needlesextending perpendicularly outward from the base generally parallel toeach other. A second piece, a female component, includes a receiverelement having openings positioned for receiving the needles of thefirst piece and a lock for holding the needles in place once received inthe openings. In use, tissue is gathered, the needles of the first pieceare pushed through the gathered tissue and the openings of the secondpiece to hold the tissue and fastener in place.

Various applicators are used to apply the fastener to the tissue. Oneapplicator includes an elongate shaft having two jaws pivotally attachedto its end. The jaws include receptacles for holding the first andsecond pieces of the fastener. The jaws push the needles of the firstpiece through the gathered tissue and the openings of the second pieceto hold the tissue and fastener in place. As will be appreciated bythose skilled in the art, because both jaws are pivotally attached tothe shaft, both pieces of the fastener sweep through arcs as the jawspivot to pierce the tissue and push the needles into the correspondingopenings. As a result of the fastener pieces sweeping through arcs, bothfastener pieces move relative to the tissue, making precise placement ofthe fastener in the tissue difficult. Even when the needles engage thetissue, the folded tissue can move relative to the female fastenercomponent before the fastener components are fastened together. Thus,there is a need for an applicator that reduces the opportunity for thetissue to move as the fastener is applied.

BRIEF SUMMARY

The present invention relates a surgical instrument for applying afastener to tissue of a patient. The fastener comprises a male componentincluding a base having at least one hole therein, a needle slideablyreceivable in the hole, and a female component including a base and arecess for receiving a leading end of the needle of the male component.The instrument comprises an elongate shaft having a working end and agrip end opposite the working end. A first jaw is pivotally mounted onthe working end of the elongate shaft. The first jaw includes a receiverfor releasably holding the base of one of the male component and thefemale component. A second jaw is statically mounted on the working endof the elongate shaft. The second jaw includes a receiver for releasablyholding the base of another of the male component and the femalecomponent. The first jaw is pivotally moveable between an open positionin which the first jaw is sufficiently spaced from the second jaw sothat tissue can be received between a female component held in thecorresponding jaw and a male component held in its corresponding jaw ofthe instrument, and a closed position in which the opening of the malecomponent is aligned with the recess of the female component. The firstjaw and/or the second jaw includes a channel for slideably receiving aneedle therein. The channel includes an opening in a face of thereceiver of the corresponding jaw. The instrument also comprises amechanism operatively connected to the first jaw for moving the firstjaw between the open position and the closed position. Further, theinstrument includes an ejector for driving the needle through theopening in the face of the receiver, through the hole in the base of themale component, through tissue held between the first jaw and the secondjaw, and into the recess of the female component.

In another aspect, the present invention includes a surgical instrumentfor applying a fastener to tissue of a patient. The fastener comprises amale component including a base having at least one hole therein, aneedle slideably receivable in the hole, and a female componentincluding a base and a recess for receiving a leading end of the needleof the male component. The instrument comprises an elongate shaft havinga working end and a grip end opposite the working end. Further, theinstrument includes a stationary jaw statically mounted on the workingend of the shaft including a receiver for holding one of the malecomponent and the female component. In addition, the instrument includesa pivoting jaw mounted on the working end of the elongate shaft adjacentthe stationary jaw including a receiver for releasably holding anotherof the male component and the female component. The pivoting jawselectively pivots between an open position in which tissue can bereceived between the jaws and a closed position in which the hole of themale component is aligned with the recess of the female component. Atleast one of the stationary jaw and the pivoting jaw includes an ejectorfor driving the needle through the hole in the male component base,through tissue between the jaws, and into the recess of the femalecomponent.

Other aspects of the present invention will be in part apparent and inpart pointed out hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a fragmented side elevation of a surgical instrument of thepresent invention;

FIG. 2 is a perspective of an end effector of the surgical instrumentshown with a fastener while in a closed position;

FIG. 3 is a the perspective of the end effector shown with a fastenerwhile in an open position;

FIG. 4 is a perspective of the end effector shown without the fastenerwhile in the closed position;

FIG. 5 is a perspective of the end effector shown without the fastenerwhile in the open position;

FIG. 6 is a perspective of the end effector shown without a portion of ahousing while in the open position;

FIG. 7 is a perspective of the end effector shown without the portion ofthe housing while in the closed position;

FIG. 8 is a perspective of the end effector shown without the portion ofthe housing while in a fully collapsed position;

FIG. 9 is a section of a grip of the instrument; and

FIG. 10 is a schematic cross section of a male jaw of an alternateembodiment of the present invention.

Corresponding reference characters indicate corresponding partsthroughout the several views of the drawings.

DETAILED DESCRIPTION

Referring now to the drawings and in particular FIG. 1, a surgicalinstrument of the present invention is generally designated by thereference number 20. The instrument is specifically adapted forperforming endoscopic surgery to fold and fasten tissue. The instrument20 generally includes an end effector (generally designated by 22) and ahandle assembly (generally designated by 24) mounted on opposite ends ofan elongate shaft 26. The shaft 26 has a working end 28, on which theend effector 22 is mounted, and a grip end 30, on which the handleassembly 24 is mounted.

In one embodiment, the shaft 26 is a flexible hollow tube having acircular cross section, a length of between about fifty centimeters (cm)and about 150 cm, and an outside diameter of between about twomillimeters (mm) and about five mm. Although the shaft 26 may be made ofother materials without departing from the scope of the presentinvention, in one embodiment the shaft is made of coiled stainless steelwire. In an alternative embodiment, it is envisioned that the shaft 26may be rigid.

The end effector 22 is adapted apply a two-part fastener 40 to tissue tohold it in position. Although the end effector 22 may be adapted toapply other types of fasteners without departing from the scope of thepresent invention, in one embodiment the end effector is adapted for usewith a two-part fastener, generally designated by 40, such as describedin U.S. Pat. No. 7,033,378. As shown in FIGS. 2 and 3, the fastener 40includes a male component, generally designated by 42, and a femalecomponent, generally designated by 44. The male component 42 includes abase 46 and needles or protrusions 48 extending outward from the base.The female component 44 includes a base 50 and openings or recesses 52for receiving the needles 48 of the male component 42. As the use andconstruction of two-part fasteners 40 such as disclosed in U.S. Pat. No.7,033,378 are well known by those skilled in the art, they will not bedescribed in further detail. The female component 44 includes a lock 54for locking the female component on the male component 42 when theprotrusions are positioned in the recesses 52.

As shown in FIG. 2, the end effector 22 includes a housing, generallydesignated by 60, mounted on the working end 28 of the shaft 26. The endeffector 22 includes a first jaw or male jaw, generally designated by62, pivotally mounted on the housing 60 with a pin 64. The male jaw 68includes a generally rectangular receptacle or receiver 66 (FIG. 4)adapted for receiving a base 46 of a male component 42 as illustrated.The end effector 22 also includes a first jaw or female jaw, generallydesignated by 68, statically mounted on the housing 60. The female jaw68 extends generally parallel to the shaft toward the grip end 30 of theshaft 26. The female jaw 68 includes a generally rectangular receptacleor receiver 70 (FIG. 4) adapted for receiving a base 50 of a femalecomponent 44 as illustrated in FIG. 2. The receptacle 64 of the male jaw68 receives the base 46 of the male component 42 as illustrated so theneedles 48 of the male component generally face the openings 52 in thefemale component 44. The instrument 20 may be actuated as explainedbelow so the male jaw 68 pivots about the pin 64 between an openposition as shown in FIG. 3 for receiving tissue between the male andfemale jaws to a closed position as shown in FIG. 2 for joining the malecomponent 42 of the fastener 40 with the female component 44 of thefastener thereby applying the fastener to the tissue of the patient.

A sleeve 72 is provided on the housing 60 for receiving a tip of anendoscope (not shown) so the physician can view the tissue as thefastener is applied. The sleeve 72 includes an opening 74 having adiameter corresponding to a small endoscope (e.g., about twelve mm). Thesleeve 72 may be mounted on the housing 60 with screw fasteners 76 asshown in FIG. 5 so the sleeve can be removed when not in use to reducethe overall effective cross-sectional area of the instrument 20.Although the sleeve 72 may be made of other materials without departingfrom the scope of the present invention, in one embodiment the sleeve ismade of a soft, low friction, lubricious material such aspolytetrafluoroethylene (PTFE), nylon, or silicone to facilitate theendoscope entering the opening 72.

As illustrated in FIGS. 4 and 5, the receptacle 70 of the female jaw 68includes a large rectangular opening 80 that is sized to receive thebase 50 of the female component 44 of the fastener 40. The receptacle 64has a ledge 82 at one end, and a lug 84 extending into the opening 80from each side. The female component 44 of the fastener 40 is insertedinto the opening 80 in a locked position (as shown in FIG. 2) so alocking feature 86 is spaced from a head 88 of the female component. Thebase 50 of the component 44 is overlapped with the ledge 82 and thelocking feature 86 and head 88 are positioned on opposite sides of thelugs 84. Once the female component 44 is in position, the lockingfeature 86 of the component is moved toward the head 88 so the femalecomponent is in an unlocked position (as shown in FIG. 3). When thefemale component 44 is in the unlocked position, the head 86 overlapsthe ledge 82 and the locking feature 86 captures the lugs 84 so thefemale component 44 is held firmly in the receptacle 70 of the femalejaw 68. As shown in FIG. 5, a torsion spring 90 is provided on thefemale jaw 62 for forcing the female component 44 of the fastener towardthe end of the jaw. The torsion spring 90 aligns the female component 44with the male component 42 as the male jaw 68 is rotated toward thefemale jaw 68. Further, the female jaw 68 includes a push rod 92 forpushing the female component 46 so it does not overlap the ledge 82 torelease the female component from the receptacle 72 as described below.

The male jaw 68 includes a rectangular recess 66 adapted to receive thebase 46 of the male component 42 of the fastener 40. The recess 66includes two counterbored holes 94 and two threaded holes 96. When themale component 42 is loaded into the recess 66 of the male jaw 68, thestub ends 98 of the protrusions 48 are received in the counterboredholes 94 to hold the protrusions in an upright configuration and preventthem from rotating into a collapsed configuration. As shown in FIG. 2,the outside of the male jaw 62 also includes a recess 100. A releasablecatch 102 is positioned in the recess 100 for engaging holes 104provided in each of the stub ends 98 of the protrusions 48 of the malecomponent 42 to hold the component in the receptacle 66. A cantileveredcover 106 is positioned above each threaded hole 96 and held in placewith a screw fastener 108. The covers 106 reduce a potential forinadvertently releasing the catch 102 from holes 104 in the stub ends 98of the protrusions 48 of the male component 42.

Referring to FIG. 5, the housing 60 includes a mount 110 to which theshaft 26 (FIG. 1) is attached. Although the mount 110 may be integrallyformed with the housing 60, in one embodiment the mount is pivotallyattached to the housing with a pin 112 to permit the end effector 22angle to be adjusted relative to the shaft 26.

As shown in FIG. 6, a first bell crank 120 is rotatably mounted in thehousing 60 for rotation about a screw fastener 122 (FIG. 2). A controlcable 124 is connected to one side of the bell crank 120 and a wirelinkage 126 is connected to the other side of the bell crank. Thelinkage 126 is wrapped around a hub 130 of the male jaw 62. When thecontrol cable 124 is pushed, the bell crank 120 rotates to push the wirelinkage 126 and rotate the male jaw 62 to the open position shown inFIG. 6. Pulling the control cable 124, rotates the bell crank 120 topull the wire linkage 126 and rotate the male jaw 62 to the closedposition shown in FIG. 7. Referring to FIG. 6, when the male jaw 62 isin the fully open position tissue may be positioned between the male andfemale jaw. As the male jaw 62 is closed, the relative position betweenthe tissue and the female jaw 68 does not change. Thus, theconfiguration described above in which only the male jaw 62 rotatesfacilitates proper positioning of the fastener 40. Once the fastener 40is applied and withdrawn from the receptacles of the male and femalejaws, 62, 68, respectively, the control cable 124 may be pulled torotate the bell crank 120 farther to pull the wire linkage 126 and closethe jaws more as shown in FIG. 8 to facilitate withdrawal of theinstrument 20 from the patient.

Referring to FIGS. 6-8, a second bell crank 140 is also rotatablymounted in the housing 60 for rotation about another screw fastener 142(FIG. 2). A control cable 144 is connected to one side of the bell crank140. A finger 146 extends from the other side of the bell crank 140. Thefinger 146 is aligned with the push rod release element 92 and the catch102 (FIG. 6) when the male jaw 62 is in the closed position (FIG. 7).When the male jaw 62 is in the closed position as shown in FIG. 6 andthe control cable 144 is pushed, the second bell crank 140 turns forcingthe finger 146 against the release element 92. As the release element 92in the female jaw 68 moves outward in the jaw, the element engages thefemale component 46 to lock it on the male component 42 and to releaseit from the receptacle 70 of the jaw. Simultaneously, the finger 146 isforced against the catch 102 to release the stub ends 98 of theprotrusions 48 from their respective counterbored holes 94, therebyreleasing the male component 42 from the recess 66 of the male jaw 62.As will be appreciated by those skilled in the art, other control meansmay be substituted for the bell cranks 120, 140 and corresponding cableswithout departing from the scope of the present invention. As numerousalternative embodiments of the control means are well within theabilities of the ordinary artisan, they will not be described in anydetail.

The handle assembly 24 operates the control the male jaw 62 to open andclose the end effector 22 and to lock and release the fastener 40 fromthe surgical instrument 20 as described in detail below. As illustratedin FIG. 9, the handle assembly 24 includes a stationary pistol grip 150and a lever 152 pivotally attached to the grip when a pin 154. The grip150 is integrally firmed with a housing 156 having a slot 158 forming inone side. The control cable 144 connected the second bell crank 140controlling the push rod 92 and releasable catch 102 for locking thefastener 40 and ejecting it from the end effector 24 is attached to asliding knob 160 captured in the slot 158. The control cable 124 extendsfrom an end of the shaft 26, around a pulley 170 mounted in the housingand connects to the lever 152 so the control cable is pulled as thelever is moved toward the pistol grip 150 to move the male jaw 62 towardthe closed position. The lever 152 is biased away from the grip 150 by afirst spring 172 extending between the lever and a mount 174 on thehousing 156. The lever 152 also includes a lock, generally designated by180, for locking it in position relative to the grip 150. The lock 180includes a pawl 182 biased against teeth 184 on the lever 152 by aspring 186 extending between the pawl and a mount 188 on the housing156. A cam 190 mounted on the housing adjacent the pawl 182 is connectedto a knob 192 (FIG. 1) that may be turned to disengage the pawl from theteeth 184 to allow the lever to return to its most forward position.

In operation, when the handle assembly lever 162 is pivoted toward tothe stationary grip 150, the male jaw 62 closes. With the male jaw 62 inthe closed position, the cross bar knob 160 is moved forward relative tothe housing 156 to lock and release of the fastener 40. After a fastener40 is released, the cam knob 192 is turned to release the lever lock 180permit the lever 152 to return to its initial position and allow themale jaw 62 to open.

Although the handle assembly 24 may be made of other materials withoutdeparting from the scope of the present invention, in one embodiment thehandle assembly is molded from polycarbonate. Although the end effector22 may be made of other materials without departing from the scope ofthe present invention, in one embodiment the end effector is made fromstainless steel.

To use the instrument 20 described above, a male component 42 of afastener 40 is loaded in the receiver 66 of the first jaw 62 so the stubends 98 of the protrusions 48 extend through the counterbored holes 94.The knob 160 is moved in the slot 158 so the catch 102 engages the holes104 in the stub ends 98 of the protrusions 48 to hold the male component42 in the receiver 66 of the first jaw. A female component 44 of thefastener 40 is loaded into the receiver 40 of the second jaw 68. Thefemale component 44 is unlocked so its lock 54 overlaps the ledge 82 ofthe second jaw 68 and the lugs 84 are captured between the lockingfeature 86 and the head 88 to retain the female component in thereceiver 40 of the second jaw.

Once the male and female components 42, 44, respectively, are loaded inthe first and second jaws 62, 68, respectively, the handle assembly 150is manipulated to position female jaw adjacent the tissue to befastened. A conventional tissue retractor (not shown) may be used toposition the tissue adjacent the female component 44 held in the femalejaw 68. Once the tissue is in position relative to the second jaw 68,the lever 152 is pulled toward the handle 150 to pivot the male jaw 62toward the tissue and the female jaw. As the male jaw 62 pivots, theprotrusions 48 of the male component 42 pierce the tissue and enter theopenings 52 in the female component 44. While the male jaw 62 is in thisclosed position, the knob 160 is moved to disengage the catch 102 fromthe openings 104 in the stub ends 98 of the protrusions 48 to releasethe male component 62. Simultaneously, the release 92 extends into theopening 80 of the female jaw 68, activating the lock 54 of the femalecomponent 44 so the protrusions 48 are locked in the openings 52.Further, the release 92 disengages the lock 54 from the ledge and spacesthe locking feature 86 from the head 88 so the lugs 84 are released,thereby releasing the female component 44 from the female jaw 68. Oncethe male and female components 42, 44, respectively, are released fromthe respective jaws, the knob 192 can be turned to release the leverlock 180, allowing the lever 152 to be moved away from the grip 150. Asthe lever 152 is moved away from the grip 150, the jaws are spaced tocompletely disengage the fastener 40. The lever 152 may again be movedtoward the grip 150 to totally collapse the jaws against each other asshown in FIG. 4, reducing the end effector 22 profile for withdrawingthe end effector from the patient. Once removed, the end effector 22 canbe reloaded and the procedure may be repeated.

Many conventional fastener systems have jaws that move relative to thehandle assembly 24, making it difficult to precisely position thefastener 40 on the tissue. The instrument 20 of the present inventionovercomes this problem by allowing only one jaw to move and keeping theother jaw stationary relative to the handle assembly 24.

FIG. 10 illustrates a male jaw 200 of another embodiment of a surgicalinstrument of the present invention. The male jaw 200 includes internalchannels 202, each of which end in an opening 204 at a face 206 of thejaw. One elongate needle 210 is slidably received in each channel 202.Each of the needles 210 includes a pointed tip 212 at a leading end ofthe needle for reducing trauma to tissue T as the end of the needleenters the tissue. Further, each needle 210 includes a head 214 on anend opposite the pointed tip 212. Although the needles 210 may haveother dimensions without departing from the scope of the presentinvention, in one embodiment each of the needles has a length of betweenabout eight mm and about fifteen mm, and a width of between about one mmand about 1.5 mm. Although the needles 210 may be made of othermaterials without departing from the scope of the present invention, inone embodiment the needles are made of Nitinol and have shape memory sothat once they are ejected from the channel 202, they return to astraight shape. An ejector rod 220 is positioned in each channel 202behind the head 214 of the needle 210. A conventional mechanism (e.g., abell crank) may be used to advance the ejector rods 220 to eject theneedles from the openings 204 in the face 206 of the jaw 200. The malejaw 200 also includes a receiver 230 for receiving a male fastener plate232 having holes 234 through which the needles 210 are driven. Theneedles continue through the tissue and into corresponding openings inthe base of a female component as described above. As will beappreciated by those skilled in the art, this embodiment permits thefasteners to be positioned very precisely, because the female componentof the fastener and the male fastener plate 232 can be preciselypositioned before the needles 210 are advanced through the tissue. Aswill be further appreciated by those skilled in the art, the needles 210may be ejected from the stationary jaw (making it the male jaw) withoutdeparting it from the scope of the present invention. Because the otherfeatures of the instrument of the second embodiment may be identical tothose of the first embodiment described above, they will not bedescribed in further detail.

When introducing elements of the present invention or the preferredembodiment(s) thereof, the articles “a”, “an”, “the” and “said” areintended to mean that there are one or more of the elements. The terms“comprising”, “including” and “having” are intended to be inclusive andmean that there may be additional elements other than the listedelements.

As various changes could be made in the above constructions withoutdeparting from the scope of the invention, it is intended that allmatter contained in the above description or shown in the accompanyingdrawings shall be interpreted as illustrative and not in a limitingsense.

1. A surgical instrument for applying a fastener to tissue of a patient,said fastener comprising a male component including a base having atleast one hole therein, a needle slideably receivable in the hole, and afemale component including a base and a recess for receiving a leadingend of said needle of the male component, said instrument comprising: anelongate shaft having a working end and a grip end opposite said workingend; a first jaw pivotally mounted on the working end of the elongateshaft including a receiver for releasably holding the base of one ofsaid male component and said female component, a second jaw staticallymounted on the working end of the elongate shaft including a receiverfor releasably holding the base of another of said male component andsaid female component; said first jaw being pivotally moveable betweenan open position in which the first jaw is sufficiently spaced from thesecond jaw so that tissue can be received between a female componentheld in the corresponding jaw and a male component held in itscorresponding jaw of the instrument, and a closed position in which theopening of the male component is aligned with the recess of said femalecomponent; at least one of said first jaw and said second jaw includinga channel for slideably receiving a needle therein, said channelincluding an opening in a face of the receiver of the corresponding jaw;a mechanism operatively connected to the first jaw for moving the firstjaw between the open position and said closed position; and an ejectorfor driving the needle through the opening in the face of the receiver,through the hole in the base of the male component, through tissue heldbetween the first jaw and said second jaw, and into the recess of thefemale component.
 2. A surgical instrument as set forth in claim 1wherein the first jaw includes a catch adapted for holding the malecomponent in the receiver.
 3. A surgical instrument as set forth inclaim 1 wherein the second jaw includes a push rod for engaging thefemale component to lock the female component on the male component andto release the female component from the receiver.
 4. A surgicalinstrument as set forth in claim 1 further comprising a handle assemblyfor holding and manipulating the instrument.
 5. A surgical instrument asset forth in claim 4 wherein the handle assembly comprises a housing anda lever pivotally attached to the housing, said mechanism beingoperatively connected to the lever so that the first jaw moves betweenthe open position and the closed position as the lever is pivoted.
 6. Asurgical instrument as set forth in claim 5 wherein: handle assemblyincludes a grip; and the mechanism moves the first jaw toward the closedposition as the lever is pivoted toward the grip.
 7. A surgicalinstrument as set forth in claim 1 wherein the ejector comprises a pushrod slideably mounted in the channel for driving the needle out of thechannel opening.
 8. A surgical instrument for applying a fastener totissue of a patient, said fastener comprising a male component includinga base having at least one hole therein, a needle slideably receivablein the hole, and a female component including a base and a recess forreceiving a leading end of said needle of the male component, saidinstrument comprising: an elongate shaft having a working end and a gripend opposite said working end; a stationary jaw statically mounted onthe working end of the shaft including a receiver for holding one ofsaid male component and said female component; a pivoting jaw mounted onthe working end of the elongate shaft adjacent the stationary jawincluding a receiver for releasably holding another of said malecomponent and said female component, said pivoting jaw selectivelypivoting between an open position in which tissue can be receivedbetween the jaws and a closed position in which the hole of the malecomponent is aligned with the recess of said female component; whereinat least one of said stationary jaw and said pivoting jaw includes anejector for driving the needle through the hole in the male componentbase, through tissue between the jaws, and into the recess of saidfemale component.
 9. A surgical instrument as set forth in claim 8further comprising a mechanism operatively connected to said pivotingjaw for moving the pivoting jaw between the open position and saidclosed position.
 10. A surgical instrument as set forth in claim 8wherein the stationary jaw receiver is adapted for holding said femalecomponent.
 11. A surgical instrument as set forth in claim 10 whereinthe stationary jaw includes a release for engaging the female componentto release the female component from the receiver.
 12. A surgicalinstrument as set forth in claim 8 wherein the pivoting jaw receiver isadapted for holding said male component.
 13. A surgical instrument asset forth in claim 12 wherein the pivoting jaw includes a catch adaptedfor holding the male component in the receiver.
 14. A surgicalinstrument as set forth in claim 8 further comprising a handle assemblyfor holding and manipulating the instrument.
 15. A surgical instrumentas set forth in claim 14 wherein the handle assembly houses at least aportion of a mechanism operatively connected to the pivoting jaw formoving the pivoting jaw between the open position and said closedposition to join the male component of the fastener with the femalecomponent of the fastener thereby applying the fastener to the tissue ofthe patient.
 16. A surgical instrument as set forth in claim 15 whereinthe handle assembly comprises a lever for actuating the mechanism tomove the pivoting jaw from the open position to the closed position.